Appeals and Grievances Administrator

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Responsibilities:

The primary purpose of the job is to: Under the general supervision of the Supervisor of Grievances, CTM and Critical Incidents, this position screens calls from members and providers regarding the Part C, Part D and Medicare-Medicaid Plan grievance processes. In addition, the Administrator will serve as a backup so when needed they will be responsible for retrieving grievances from the Customer Service database and email distribution lists and assign them appropriately to Grievance Investigators. Will support grievance needs of our Medicare Advantage D-SNP and MMP membership.

• Complete First Call Resolution cases, including intake, determining if case is fully resolved, generate letters and close case. If cases are not fully resolved, convert to standard grievance and assign to an investigator.
• Generating Acknowledgement Letters to mail to appellants and answering general appeal status questions.
• Assisting Investigation Specialists with grievance resolutions.

• Limited availability on weekends and holidays to monitor work queues.

Education/Experience:

• High School/GED.
• Associate’s Degree preferred.
• 1 to 3 years Medicare/Medicaid experience and minimum of 2 years of experience dealing with the public.
• Medicare Advantage and MMP experience.
• Medical terminology, ICD, CPT and coding experience.
• Experience handling multiple call lines and triaging calls.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.